中国老年住院患者认知障碍的患病率及其与 1 年不良健康结局的关系：一项多中心队列研究。
Prevalence of cognitive impairment in Chinese older inpatients and its relationship with 1-year adverse health outcomes: a multi-center cohort study.
机构信息
Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, 5 Dongdan Santiao, Beijing, 100005, China.
Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China.
出版信息
BMC Geriatr. 2021 Oct 25;21(1):595. doi: 10.1186/s12877-021-02556-5.
BACKGROUND
Previous studies on the relationship between cognitive impairment and adverse outcomes among geriatric inpatients are not representative of older inpatients in China because of insufficient sample sizes or single-center study designs. The purpose of our study was to examine the prevalence of cognitive impairment and the relationship between cognitive impairment and 1-year adverse health outcomes in older inpatients.
METHODS
This study was a large-scale multi-center cohort study conducted from October 2018 to February 2020. Six tertiary hospitals across China were selected using a two-stage cluster sampling method, and eligible older inpatients were selected for the baseline survey and follow-up. The Mini Cognitive Scale and the FRAIL scale were used to screen for cognitive impairment and frailty, respectively. The EuroQol-5 Dimension-5 Level questionnaire was used to assess health-related quality of life (HRQoL). We used a generalized estimating model to evaluate the relationship between cognitive impairment and adverse outcomes.
RESULTS
The study included 5008 men (58.02%) and 3623 women (41.98%), and 70.64% were aged 65-75 years, and 26.27% were aged 75-85 years. Cognitive impairment was observed in 1756 patients (20.35%). There were significant differences between participants with cognitive impairment and those with normal cognitive function for age, gender, surgery status, frailty, depression, handgrip strength and so on. After adjusting for multiple covariates, compared with patients with normal cognitive function, the odds ratio for 1-year mortality was 1.216 (95% confidence interval [CI]: 1.076-1.375) and for 1-year incidence of frailty was 1.195 (95% CI: 1.037-1.376) in patients with cognitive impairment. Similarly, the regression coefficient of 1-year HRQoL was - 0.013 (95% CI: - 0.024-- 0.002). In the stratified analysis, risk of adverse outcome within 1 year was higher in older patients with cognitive impairment aged over 75 years than those aged 65-74 years.
CONCLUSIONS
We revealed that cognitive impairment was highly correlated with occurrence of 1-year adverse health outcomes (death, frailty, and decreased HRQoL) in older inpatients, which provides a basis for formulating effective intervention measures.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, ChiCTR1800017682 , registered 09 August 2018.
背景
之前关于老年住院患者认知障碍与不良结局之间关系的研究，由于样本量不足或单中心研究设计，不能代表中国的老年住院患者。本研究旨在调查认知障碍的发生率，以及认知障碍与老年住院患者 1 年不良健康结局之间的关系。
方法
这是一项大规模的多中心队列研究，于 2018 年 10 月至 2020 年 2 月进行。采用两阶段整群抽样方法，选取中国 6 家三级医院，对符合条件的老年住院患者进行基线调查和随访。采用简易认知量表和衰弱量表分别筛查认知障碍和衰弱。采用欧洲五维健康量表 5 维问卷评估健康相关生活质量（HRQoL）。采用广义估计模型评估认知障碍与不良结局之间的关系。
结果
研究纳入 5008 名男性（58.02%）和 3623 名女性（41.98%），70.64%年龄为 65-75 岁，26.27%年龄为 75-85 岁。1756 名患者（20.35%）存在认知障碍。认知障碍患者与认知功能正常患者在年龄、性别、手术情况、衰弱、抑郁、握力等方面存在显著差异。调整多个协变量后，与认知功能正常患者相比，认知障碍患者 1 年死亡率的比值比（OR）为 1.216（95%置信区间[CI]：1.076-1.375），1 年衰弱发生率的 OR 为 1.195（95%CI：1.037-1.376）。同样，1 年 HRQoL 的回归系数为-0.013（95%CI：-0.024--0.002）。分层分析显示，年龄超过 75 岁的老年认知障碍患者发生 1 年内不良结局的风险高于 65-74 岁患者。
结论
本研究揭示了认知障碍与老年住院患者 1 年内不良健康结局（死亡、衰弱和 HRQoL 下降）密切相关，为制定有效的干预措施提供了依据。
试验注册
中国临床试验注册中心，ChiCTR1800017682，注册于 2018 年 8 月 9 日。
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